Prediction Of Adverse Pregnancy Outcomes Research Articles

Fetal Splenic Artery Pulsatility Index May Predict the Need for Neonatal Intensive Care in Gestational Diabetes Class A1 Cases.

The fetal splenic artery pulsatility index is a parameter that reflects fetal well-being and has been used as a predictor of adverse pregnancy outcomes. The aim of this study was to investigate the predictive value of the splenic artery pulsatility index in gestational diabetes mellitus class A1 cases for intensive care unit admission. In this prospective case-controlled study, only sixty single pregnancy cases diagnosed with gestational diabetes mellitus class A1 were evaluated. Fetal splenic artery Doppler parameters such as peak systolic velocity, pulsatility index, resistivity index, and end-diastolic velocity were measured in all cases. The rate of requirements for the neonatal intensive care unit was noted. In cases requiring fetal intensive care, the fetal splenic pulsatility index was found to be statistically significantly lower than in healthy cases without it (0.94 ± 0.29 vs. 1.70 ± 0.53, respectively, p < 0.001, Student's t-test). When the fetal splenic PI cutoff value was selected as 1.105 cm3, the sensitivity was calculated as 97.9% and the specificity as 58.3% for predicting the need for fetal intensive care (AUC 0.968, p < 0.001, 95% CI 0.929-0.998). The use of a low fetal splenic artery PI parameter is a significant and good indicator for predicting the need for fetal intensive care according to the binary logistic regression analysis result (p = 0.006). This study suggests that evaluation of fetal splenic artery Doppler in mothers with gestational diabetes mellitus may be used to predict neonates requiring a newborn intensive care unit. Therefore, it is recommended that obstetricians use this simple, rapid, and valuable evaluation of fetal splenic artery Doppler and alert the neonatologist that a newborn intensive care unit may be required.

Perinatal substance use disorder: Examining the impact on adverse pregnancy outcomes

ObjectiveSubstance use disorder is a growing concern in the USA, especially among pregnant women. This study was undertaken to assess the impact of substance use disorder on adverse pregnancy outcomes using a nationwide sample of inpatient pregnancy hospitalizations in the USA, and to elucidate the influence on each type of adverse pregnancy outcome. Study designA cross-sectional analysis of inpatient pregnancy hospitalizations in the USA from the Healthcare Cost and Utilization Project National Inpatient Sample from 2016 to 2020 was conducted. International Classification of Diseases – 10th revision and diagnosis-related group codes were used to identify inpatient pregnancy-related delivery hospitalizations with a substance use disorder and/or adverse pregnancy outcomes. Propensity score matching and multiple logistic regression analyses were undertaken to predict the likelihood of adverse pregnancy outcomes among pregnancy hospitalizations with and without substance use disorder. Subgroup analyses were performed to estimate the impact of substance use disorder on each adverse pregnancy outcome. ResultsFrom 3,238,558 hospitalizations, the prevalence of adverse pregnancy outcomes was substantially higher among pregnancy hospitalizations with substance use disorder (35.6 %) compared with pregnancy hospitalizations without substance use disorder (25.1 %, p < 0.001). After matching and model adjustment for sociodemographic covariates, substance use disorder was identified as an independent predictor of adverse pregnancy outcomes [adjusted odds ratio (aOR) 1.47, 95 % confidence interval (CI) 1.45–1.49]. In subgroup analyses based on type of adverse pregnancy outcome, the greatest exposure risks were fetal growth restriction (aOR 1.96, 95 % CI 1.91–2.01), antepartum hemorrhage (aOR 1.79, 95 % CI 1.73–1.85) and preterm birth (aOR 1.65, 95 % CI 1.62–1.68). ConclusionPatients with substance use disorder are at higher risk of adverse pregnancy outcomes, particularly fetal growth restriction, antepartum hemorrhage and preterm birth.

Gestational weight gain and pregnancy outcomes in Chinese women with type 2 diabetes mellitus: evidence from a tertiary hospital in Beijing.

To examine the effects of gestational weight gain on pregnancy outcomes and determine the optimal range of weight gain during pregnancy for Chinese women with type 2 diabetes mellitus. This retrospective cohort study included 691 Chinese women with type 2 diabetes mellitus from 2012 to 2020. The study utilized a statistical-based approach to determine the optimal range of gestational weight gain. Additionally, multivariate logistic regression analysis was conducted to assess the impact of gestational weight gain on pregnancy outcomes. (1) In the obese subgroup, gestational weight gain below the recommendations was associated with decreased risks of large for gestational age (adjusted odds ratio [aOR] 0.19; 95% confidence interval [CI] 0.06-0.60) and macrosomia (aOR 0.18; 95% CI 0.05-0.69). In the normal weight subgroup, gestational weight gain below the recommendations of the Institute of Medicine was associated with decreased risks of preeclampsia (aOR 0.18; 95% CI 0.04-0.82) and neonatal hypoglycemia (aOR 0.38; 95% CI 0.15-0.97). (2) In the normal weight subgroup, gestational weight gain above the recommendations of the Institute of Medicine was associated with an increased risk of large for gestational age (aOR 4.56; 95% CI 1.54-13.46). In the obese subgroup, gestational weight gain above the recommendations was associated with an increased risk of preeclampsia (aOR 2.74; 95% CI 1.02, 7.38). (3) The optimal ranges of gestational weight gain, based on our study, were 9-16kg for underweight women, 9.5-14kg for normal weight women, 6.5-12kg for overweight women, and 3-10kg for obese women. (4) Using the optimal range of gestational weight gain identified in our study seemed to provide better prediction of adverse pregnancy outcomes. For Chinese women with type 2 diabetes, inappropriate gestational weight gain is associated with adverse pregnancy outcomes, and the optimal range of gestational weight gain may differ from the Institute of Medicine recommendations.

Semi-quantitative metalloproteinase-8 rapid test for the prediction of adverse pregnancy outcomes in patients with preterm premature rupture of membranes

ObjectiveWe aimed to determine whether the semi-quantitative metalloproteinase-8 (MMP-8) bedside test is a worthwhile indicator in reflecting the severity of of intra-amniotic inflammation (IAI) and in predicting adverse pregnancy outcomes. Study DesignThis retrospective cohort study comprised 76 singleton-pregnant women admitted to the Seoul National University Bundang Hospital with a diagnosis of preterm premature rupture of membranes (preterm PROM) between 20 weeks 0 days and 33 weeks 6 days of gestation who underwent trans-abdominal amniocentesis to confirm intra-amniotic infection by positive results for aerobic/anaerobic bacteria, fungi, and genital mycoplasma and evaluate lung maturity. The semi-quantitative MMP-8 rapid test kit employs a colourimetric assay to quantify MMP-8 levels in amniotic fluid (AF), expressing results from 0 to 100 percent. Participants were divided into three groups: group 1, including negative MMP-8 test with colour scale of 0 % (negative, n = 17); group 2, including positive MMP-8 test with colour scale < 51 % (weak positive, n = 21); and group 3, including positive MMP-8 test with colour scale of 51 %–100 % (strong positive, n = 38). ResultsApproximately 78 % (59/76) of the participants showed a positive MMP-8 test result; all culture-proven AF samples (33.3 % [25/75]) yielded positive MMP-8 test, categorizing these patients into either group 2 or group 3. A significant trend was observed where the rate of positive culture-proven samples increased with the progression from group 1 (negative) to group 3 (strong positive). Both white blood cell counts in AF and maternal serum C-reactive protein levels were found to escalate with the progression of test results from negative to strong positive. This progression was associated with an increased risk of spontaneous preterm birth within 48 h, 7 days, and 14 days from amniocentesis and within 34 weeks of gestation. ConclusionThe more the test results progress from negative to strong positive, the shorter the interval from amniocentesis to delivery becomes, and the higher the risk of intra-amniotic infection, spontaneous preterm delivery, and other perinatal complications. This relationship highlights the critical value of the semi-quantitative MMP-8 rapid test in predicting adverse pregnancy outcomes in patients with preterm PROM.

Use of cell-free non-invasive prenatal testing in pregnancies affected by placental mosaicism.

To evaluate cell-free non-invasive prenatal testing (cfNIPT) in pregnancies affected by mosaicism. We assessed paired cfNIPT and chorionic villus sample (CVS) results from the same pregnancies in a case series of mosaicism detected in Central and North Denmark Regions from April 2014 to September 2018. Indications for the clinically obtained CVS, pregnancy markers and outcome were retrieved from The Danish Fetal Medicine Database. Mosaicisms in CVS involved common aneuploidy, n=14; sex chromosomal aneuploidies, n=14; rare autosomal trisomies (RATs), n=16 and copy number variants (CNVs) >5Mb, n=9. Overall, 24/53 (45.3%; CI 95%: 31.8%-59.4%) of cases with mosaicism were detected by cfNIPT; highest for RATs (56%) and lowest for CNVs (22%). CfNIPT more commonly detected high-level than low-level mosaic cases (p=0.000). CfNIPT detected 7/16 (43.8%; CI 95%: 21%-69%) clinically significant mosaic cases, either true fetal mosaicism or confined placental mosaicisms with adverse pregnancy outcome. There was a trend toward a higher risk for adverse outcome in pregnancies where mosaicism was detected by cfNIPT compared to pregnancies where mosaicism was not detected by cfNIPT (p=0.31). CfNIPT has a low detection rate of mosaicism, including pregnancies with clinically significant mosaicism. However, abnormal cfNIPT results may be a predictor of adverse pregnancy outcomes.

Does the combination of four OGTT values enhance the prediction of adverse pregnancy outcomes? Insights from a retrospective cohort study.

To explore the correlation between a singular value of additive OGTT scores and adverse maternal and neonatal outcomes. We postulated that a higher additive OGTT score would predict poorer maternal and neonatal outcomes. In this retrospective cohort study, data were collected from all women with a documented complete OGTT result and subsequent diagnosis of GDM. The additive OGTT score was calculated by adding each individual hourly glucose measurement. Maternal demographics, pregnancy and labor characteristics, and neonatal outcomes were compared between the lower-sum and higher-sum OGTT groups. A multivariate regression analysis was performed to identify confounders associated with adverse outcomes. In this study, a total of 1497 patients were assessed. The group with higher-sum OGTT scores was characterized by increased rates of GDMA2 (p = 0.008), higher insulin doses (p = 0.009), and higher rates of composite maternal and neonatal adverse outcomes (p = 0.021 and p = 0.030, respectively) compared to the lower-sum OGTT group. The additive OGTT score may aid in predicting the need for insulin treatment, labor course, and neonatal outcomes in GDM patients.

Post-COVID-19 Fetal Cardiac Morphology and Systolic Evaluation in Infected Pregnant Women by Fetal Heart Quantification Technology.

Due to the government's liberalization of epidemic control, the current 2019 novel coronavirus disease (COVID-19) has started to spread widely within China. This study aimed to use the fetal heart quantification (fetal HQ) technique to assess the cardiac function and morphology of the fetuses of pregnant women diagnosed with COVID-19 in the early stages of pregnancy. Exactly 86 pregnant women diagnosed with COVID-19 infection in early pregnancy (COVID-19 group) and 90 healthy pregnant women (control group) who underwent fetal echocardiography were prospectively included in this study. The fetal HQ technique was applied to compare the differences in the global sphericity index (GSI), global strain values (GS), fractional area change (FAC), and 24-segment fractional shortening (FS) of the left and right ventricles, between the COVID-19 group and the control group. Compared with the control group, the differences in GS and 24-segment FS of the left ventricle in the COVID-19 group were not statistically significant. However, the COVID-19 group showed lower GSI values compared with the control group (1.24 vs 1.28). FAC (48.12%) of the left ventricle and GS (-23.55%), FAC (41.74%) of the right ventricle in the COVID-19 group were reduced compared with FAC (50.50%) of the left ventricle and GS (-27.63%), FAC (46.01%) of the right ventricle in the control group. Segmental analysis revealed reduced FS in segments 20-24 in the COVID-19 group compared with the control group. Right ventricular GS was an independent predictor of adverse pregnancy outcome with an optimal cutoff value of -18.66%. The results suggest that COVID-19 infection in early pregnancy may have a negative impact on fetal cardiac morphology and function. Fetal HQ may offer a new assessment method for the early identification of fetal cardiac alterations in pregnant women infected with COVID-19.

Post-load glucose is a stronger predictor of adverse pregnancy outcomes than first-trimester HbA1c in women without gestational diabetes.

A debate exists on the relation of adverse pregnancy outcomes with glycemic levels in early pregnancy. We aimed to investigate the association of maternal characteristics including post-load glucose and first-trimester HbA1c test results with adverse pregnancy outcomes in women without gestational diabetes mellitus. A dataset (January 2011 and September 2017) from a hospital prenatal clinic was explored to find the important predictors of adverse pregnancy outcomes using maternal characteristics and glucose assessments in mothers without gestational diabetes. We used two machine learning algorithms to capture nonlinearity in selecting important maternal characteristics and developed predictive models for each outcome. In total, 1,618 pregnant women were included in the analytic dataset with a mean (SD) age of 26.8 (3.5) years and gravida of 1.7 (0.9). Important associations were detected between maternal features and primary cesarean section, fetal distress, premature rupture of membranes, macrosomia, small or large for gestational age, APGAR <7 at 1 or 5 min, hyperbilirubinemia, and poly- or oligo-hydramnios. Overall, the predictive models showed good performance and large areas under the curves (0.732, 0.765, 0.646, 0.651, 0.730, 0.646, 0.684, 0.716, and 0.678, respectively). Specifically, they had high positive likelihood ratios. High glucose levels were associated with adverse pregnancy outcomes. Post-load glucose was the most reliable test for predicting the outcomes. Overall, fasting blood sugar was of more predictive value than HbA1c. Our study showed that further research should account for the nonlinearity and interactions inherent in the data.

676 White coat hypertension validated on home blood pressure monitoring as predictor of adverse pregnancy outcomes

676 White coat hypertension validated on home blood pressure monitoring as predictor of adverse pregnancy outcomes

Chorionic bump: ultrasound predictor of adverse pregnancy outcome

For the first time R. Harris et al. in 2006 a chorionic bump was described, detected by ultrasound examination in the first trimester of pregnancy, having characteristic ultrasound signs and localization. Modern knowledge about the etiology and clinical significance of chorionic bump for predicting the outcome of pregnancy is insufficient and contradictory. Inconsistency of the data may be due to the rarity of occurrence, a small sample of the studied groups, the lack of histopathological studies. Among doctors who make ultrasound investigations there is a low awareness of chorionic bump and as a result an erroneous interpretation of sonography data. Nevertheless, there is more and more evidence that this sign is a predictor of an adverse outcome of pregnancy. Doctors who make ultrasound investigations in the first trimester of pregnancy should be aware of the chorionic bump and be able to differentiate it with other pathological conditions. If a chorionic bump is detected, ultrasound examination in dynamics should be recommended. Based on the study of domestic and foreign literature, this scientific review presents modern ideas about the pathomorphology of chorionic bump, informations about significance in terms of predicting the outcome of pregnancy, and the main aspects of ultrasound diagnostics and differential diagnosis of this pathology.

EP13.33: Prediction of adverse pregnancy outcomes using fetal abdominal circumference at 11 and 13+6 weeks of gestation

EP13.33: Prediction of adverse pregnancy outcomes using fetal abdominal circumference at 11 and 13+6 weeks of gestation

Cerebroplacental Ratio Percentile: A Predictor of Adverse Pregnancy Outcome

Cerebroplacental Ratio Percentile: A Predictor of Adverse Pregnancy Outcome

OP02_6. Nationwide pregnancy outcomes after kidney transplantation and prediction of adverse pregnancy outcomes: A Dutch cohort study

OP02_6. Nationwide pregnancy outcomes after kidney transplantation and prediction of adverse pregnancy outcomes: A Dutch cohort study

Higher serum AMH level is associated with better pregnancy outcomes of IVF/ICSI assisted pregnancy in infertile patients under 35 years old.

This study aimed to investigate the effect of anti-Mullerian hormone (AMH) on the pregnancy outcome of infertility assisted by IVF/Micro-Insemination/Embryo Transfer Infertility Assistance (IVF/ICSI-ET). A total of 324 patients under the age of 35 who received IVF/ICSI-ET assistance in our center were included in this analysis. AMH levels of these patients were measured by chemiluminescence method and divided into clinical pregnancy group (175 cases) and non-pregnancy group (149 cases) according to the final pregnancy outcome. The relationship between the two groups' pregnancy outcomes and AMH levels was analyzed. The above association was re-evaluated after excluding patients with polycystic ovary syndrome. There was no significant difference in age, body mass index (BMI), follicle-stimulating hormone (FSH), and 2 pronucleus (PN) between clinical and non-clinical pregnancy groups. Compared with the clinical pregnancy group, the level of AMH in the non-pregnancy group was significantly lower (p < 0.05). A higher AMH level was closely related to better IVF/ICSI-ET assisted pregnancy outcome in vitro. After excluding AMH abnormalities, the AMH level was still significantly associated with pregnancy outcomes of in vitro IVF/ICSI-ET-assisted pregnancy. Our results show a correlation between AMH level and pregnancy outcome of in vitro IVF/ICSI-ET assisted pregnancy. For women under age 35, lower AMH levels may be one of the predictors of adverse pregnancy outcomes. For patients with low AMH level, it is suggested to strengthen monitoring to ensure the safety and smoothness of the pregnancy process.

First-trimester neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic immune-response index (SIRI) as predictors of composite adverse outcomes in pregnant women with Familial Mediterranean fever.

To evaluate the utility of the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic immune-response index (SIRI) in the prediction of adverse pregnancy outcomes in pregnant women with Familial Mediterranean fever (FMF) MATERIAL AND METHODS: This retrospective case-control study was conducted between 2019-2023. First-trimester NLR, SII (NLR X platelet count), and SIRI (NLR X monocyte count) values were compared between pregnant women with FMF (n=85) and without FMF (n=105). Thereafter, pregnant women with FMF were divided into two groups: 1) FMF with perinatal complications (n=30), and 2) FMF without perinatal complications (n=55). NLR, SII, and SIRI values were compared between the two subgroups. Finally, an ROC analysis was performed to determine optimal cut-off values for NLR, SII, and SIRI in the prediction of composite adverse pregnancy outcomes. The FMF group had significantly higher first-trimester NLR, SII, and SIRI values compared to the controls. The FMF with perinatal complications group had significantly higher NLR, SII, and SIRI values than the FMF group without perinatal complications (p<0.05). Optimal cut-off values were 4.89 (80% sensitivity, 78.2% specificity), 1180.6 (76.7% sensitivity, 72.7% specificity), and 1.9 (83.3% sensitivity,72.7% specificity) for NLR, SII, and SIRI, respectively. SII, SIRI, and NLR may be used to predict adverse pregnancy outcomes in pregnant women with FMF.

Artificial intelligence in obstetric ultrasound: A scoping review.

The objective is to summarize the current use of artificial intelligence (AI) in obstetric ultrasound. PubMed, Cochrane Library, and ClinicalTrials.gov databases were searched using the following keywords "neural networks", OR "artificial intelligence", OR "machine learning", OR "deep learning", AND "obstetrics", OR "obstetrical", OR "fetus", OR "foetus", OR "fetal", OR "foetal", OR "pregnancy", or "pregnant", AND "ultrasound" from inception through May 2022. The search was limited to the English language. Studies were eligible for inclusion if they described the use of AI in obstetric ultrasound. Obstetric ultrasound was defined as the process of obtaining ultrasound images of a fetus, amniotic fluid, or placenta. AI was defined as the use of neural networks, machine learning, or deep learning methods. The authors' search identified a total of 127 papers that fulfilled our inclusion criteria. The current uses of AI in obstetric ultrasound include first trimester pregnancy ultrasound, assessment of placenta, fetal biometry, fetal echocardiography, fetal neurosonography, assessment of fetal anatomy, and other uses including assessment of fetal lung maturity and screening for risk of adverse pregnancy outcomes. AI holds the potential to improve the ultrasound efficiency, pregnancy outcomes in low resource settings, detection of congenital malformations and prediction of adverse pregnancy outcomes.

Assessment of Maternal Abdominal Subcutaneous Fat Thickness (Sft) Measured by Ultrasound as an Independent Predictor of Adverse Pregnancy Outcomes

Introduction: Obese pregnant women are at increased risk for a variety of maternal and perinatal complications. The maternal risks related to obesity include Gestational Diabetes mellitus, Preeclampsia, increased caesarean sections. The fetes is at risk of stillbirth, preterm birth and congenital anomalies. This study focuses on the use of Maternal abdominal subcutaneous fat thickness (SFT) as a surrogate measure for central obesity as measured by ultrasound, and determining its efficacy compared to BMI in predicting obesity related pregnancy complications. Objective: To measure mid-trimester SFT in antenatal women and establish SFT as an independent predictor of obesity related adverse pregnancy outcomes Methods: This was a prospective cohort study. 150 pregnant women between 20-40 years of age were recruited. Demographic data of each participant was collected from the OPD. USG for abdominal subcutaneous fat thickness (SFT) was done at 18-22 wks period of gestation. The participants were followed up to labour. Adverse pregnancy outcomes and their correlation with the SFT measured was studied. Results: There was significant positive correlation between BMI and SFT (r=0.591, p&lt;0.001) .A positive correlation was noticed between BMI and adverse pregnancy outcomes such as PIH, GDM , preterm birth , postdates and NICU admissions. SFT independently showed a positive correlation with the above parameters. The mean SFT among women without PIH was 11.45 mm, and with PIH was 16.48 mm[p &lt;0.001].Mean SFT were 11.68mm and 16.24 mm among the ladies without and with GDM respectively[p&lt;0.001]. The mean SFT for term pregnancies was 12.06 mm whereas the mean SFT for preterm births was 14.21 showing positive correlation between SFT and preterm birth. SFT also showed positive correlation with need for NICU admission for neonates [ SFT avg being 11.72mm and 14.94 mm in the 2 groups]. A comparative analysis was done between BMI and SFT regarding their correlation to the various outcomes. SFT showed higher correlation coefficients for these variables than BMI, with lower p values suggesting more statistical significance. Conclusion: BMI showed a positive correlation with adverse pregnancy outcomes in mother as well as fetes, SFT showed greater and more statistically significant correlation for adverse outcomes. Thus it was concluded that SFT is a better independent predictor of obesity related adverse pregnancy outcomes.

The role of first-trimester NLR (neutrophil to lymphocyte ratio), systemic immune-inflammation index (SII), and, systemic immune-response index (SIRI) in the prediction of composite adverse outcomes in pregnant women with systemic lupus erythematosus

To evaluate the utility of neutrophil to lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic immune-response index (SIRI) in the prediction of adverse pregnancy outcomes in pregnant women with systemic lupus erythematosus (SLE). This retrospective case-control study was conducted in Ankara City Hospital perinatology clinic between 2019 and 2023. First-trimester NLR, SII (NLR X platelet count), and SIRI (NLR X monocyte count) values were compared between pregnant women with SLE (n = 29) and low-risk controls (n = 110). Afterward, pregnant women with SLE were divided into two groups: 1) SLE with perinatal complications (n = 15) and 2) SLE without perinatal complications (n = 14). NLR, SII, and SIRI values were compared between the two subgroups. Finally, a ROC analysis was performed to determine optimal cut-off values for NLR, SII, and SIRI in the prediction of composite adverse pregnancy outcomes. The study group had significantly higher first-trimester NLR, SII, and SIRI values compared to the controls. The SLE with perinatal complications group had significantly higher NLR, SII, and SIRI values than the SLE group without perinatal complications (p < 0.05). Optimal cut-off values were 6.5 (66.7% sensitivity,71.4% specificity), 1612.6 (73.3% sensitivity, 71.4% specificity), and, 4.7 (73.3% sensitivity, 77.6% specificity) for NLR, SII, and SIRI, respectively. SII, SIRI, and NLR may be used to predict adverse pregnancy outcomes in pregnant women with SLE.

The Assessment of Natural Vaginal Delivery in Relation to Pregnancy-Related Anxiety-A Single-Center Pilot Study.

Pregnancy-related anxiety (PrA) is a specific type of anxiety experienced during the perinatal period. It may concern a person's health and physical appearance, fetal development, hospital and health care experiences, impending childbirth, and early parenthood. PrA is considered to be a stronger predictor of adverse pregnancy outcomes than general anxiety and depression. The purpose of this research was to conduct a pilot study and evaluate the course of vaginal birth (VB) in relation to PrA levels in a population of pregnant women with low obstetrical risk. This cross-sectional exploratory study included 84 pregnant women (with a mean age of 28.61 ± 4.99) (without cesarean section (CS) indications and with a low risk of complications during VB). Research questionnaires were distributed and filled in in person during the course of hospitalization. Groups that varied at the level of PrA were compared using the Wilcoxon rank-sum test, Fisher's exact test, or chi-square test of independence, as appropriate. More than two-thirds of the respondents (72.6%) were medicated in labor. Women with high PrA, selected based on a cut-off point with a total PRAQ-R2 score of 60, experienced significantly longer first (start of established labor to fully dilated cervix) and second (lasts from when cervix is fully dilated until the birth) periods of labor, instrumental delivery, or emergency CS. In the group with high PrA levels, a episiotMmentation of evidence-based recommendations for the affected population to identify and further treat women with elevated levels of PrA.

Antepartum and Postpartum Monocyte Distribution Width Values in Patients With Histopathologic Chorioamnionitis [ID: 1376799

INTRODUCTION: In nonpregnant adults presenting to the emergency department, monocyte distribution width (MDW) progressively increases with infection severity. While studies have shown that chorioamnionitis alters monocyte response, MDW has not been well studied in pregnancy. The primary aim of the study was to examine MDW values antepartum and postpartum in patients with histopathologic chorioamnionitis. METHODS: A retrospective electronic chart review was performed from an urban safety net hospital. Patients with an MDW value on admission and postpartum day number 1 (PPD1), in addition to postpartum placental histopathologic examination, were included in the study. Institutional review board approval was obtained (UMKC #2093657). The Mann-Whitney U test was utilized for statistical analyses. RESULTS: Of the 419 obstetric patient encounters reviewed, 89 encounters met inclusion criteria, of which 32% were diagnosed with histopathologic chorioamnionitis. There was no difference (P&gt;.05) in median MDW at the time of admission between those with and without chorioamnionitis on histopathology (18.78 U versus 18.53 U, P=.602). However, the median MDW was significantly higher on PPD1 in patients diagnosed with chorioamnionitis compared to those without chorioamnionitis on postpartum histopathology (21.48 U versus 19.56 U, P=.001). CONCLUSION: In the setting of histopathologic chorioamnionitis, a significant elevation in postpartum MDW values compared to admission values suggests intrapartum MDW values increase as the infection develops. Additional longitudinal and prospective analysis of intrapartum MDW values may help characterize this rise and establish its potential role as a predictor of adverse pregnancy outcomes.